A phase I/II study of hypofractionated whole abdominal radiation therapy in patients with chemoresistant ovarian carcinoma: Karnofsky score determines treatment outcome

Purpose: Radiation therapy can provide useful palliation in chemorefractory ovarian cancer patients. The purpose of this study was to prospectively st udy the palliative effect of a hypofractionated radiation treatment regimen , Change in quality-of-life scores (Functional Assessment of Cancer Therapy [FACT], Karnofsky scale), pain score, and tolerance to therapy were also a ssessed. Methods and Materials: A single-institution Phase I/II trial was initiated in patients with chemoresistant recurrent or progressive ovarian cancer. Al l patients had symptomatic and measurable intra-abdominal disease. Patients were treated with a single radiation fraction (700 cGy) or two fractions ( 300 cGy twice a day) to the whole abdomen over 1 day, Quality-of-life scale (FACT G version 2) was assessed at baseline and 1 and 3 months following t reatment. Karnofsky scale and pain score were also evaluated in the same ti me frame. Results: Sixteen patients were prospectively entered into this protocol bet ween February 1996 and September 1998. Twelve patients received a single 70 0 cGy fraction and four 300 cGy twice a day. All were heavily pretreated an d 9 (56%) had a poor performance status prior to treatment. Symptoms needin g palliation included pain (14), ascites (10), and bleeding (2), Symptomati c improvement occurred in all patients with pain (5 complete response [CR] and 7 partial response [PR], all patients with bleeding (CR 2), and two (20 %) with ascites. Five patients (31%) had a reduction in lesion size documen ted radiologically in three, The mean duration of response was 22 weeks in patients with a Karnofsky score >70, Thirteen patients developed transient nausea and vomiting which resolved in 48 hours in all. All patients develop ed a transient lymphopenia. Thirteen patients completed a follow-up quality -of-life scale. There was an improvement in the physical and functional com ponents of the scale in patients with Karnofsky score of 90-100, There was no improvement in quality of life in patients with Karnofsky score <90 desp ite symptomatic response, Median survival was 3 months from the date of tre atment. Conclusion: Hypofractionated radiation therapy is an effective palliative t reatment for end-stage ovarian cancer patients, Karnofsky score can help de termine the duration of response and survival for this high-risk population . (C) 2000 Elsevier Science Inc.